Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair
Authors: Stefanie M. Croghan, Helen M. Mohan, Kieran J. Breen, Ruth McGovern, Kathleen E. Bennett, Michael R. Boland, Muhammed Elhadi, Jessie A. Elliott, Anna C. Fullard, Peter E. Lonergan, Frank McDermott, Asif Mehraj, Francesco Pata, David M. Quinlan, Des C. Winter, Jarlath C. Bolger, Christina A. Fleming, Pablo Alberto Farinelli, Maria Jimena Alaniz Alday, Nicolás L. Avellaneda, María M. Goya, Gastón A. Clementé, Juan Cruz Lopez, David Proud, Natassia Shulman, Dora Huang, Wael Jamel, Sonia Gill, Thomas Arthur, Daisy Swindon, Amy Frank, Roy Teng, Irene Chua, Nicole Chong, Amy Hannigan, Madhu Srinivasan, Aysha Al Bastaki, Sharifa Ahmad, Isam Juma, Wah Yang, Huaxi Wang, Shuwen Jiang, Eddy P Lincango Naranjo, Carla M Dominguez, Luis F Huilca, Jose R Negrete Ocampo, Ahmed Nafea, Ahmed K. Awad, Merihan A. Elbadawy, Aya Abdulilah Abdulmonem, Mahmoud Shaban Abdelgalil, Salma Tarek Helmy, Sally Ahmed Abd El-razik, Laila Raafat Mabrouk, Ahmed Hassan A.Rady, Ahmed Shaheen, Moataz Ewedah, Marina Farag, Yousef Tanas, Yomna Dean, Maha Ghanem, Amir F. Asla, Ahmed M. Ghatwary, Menan A. Elsadek, Aalaa Saad, Ramy A. Hassan, Mohamed O. Herdan, Mahmoud A. Nassar, Sherif Alaa, Areej A. Khamis, Hadeer M.S. Youssef, Mohamed A. El Sherpiny, Eslam S.A.M. Shehata, Sandy A. Taha, Ahmed A.A.A Zahran, Mohamed Al-Nagdy, Somaya Z.E Sayed Hafez, Shymaa M. Abo Ghanima, Sherif Farahat, Fatma M. Morgan, Shaimaa M. Mahfouz, Hossam Elfeki, Hosam Elghadban, Mostafa Shalaby, Mohamed Shetiwy, Mohamed Mostafa, Ahmad Sakr, Ahmed Elsayed, Kareem Sadek, Maher Eldeghedi, Mohamed Nader, Reem Elsaadany, Yousef Hesham, Omar Attiya, Abdelrahman Shaaban, Yara Sakr, Mohammed Alharazin, Mohammed A. Omar, Marwa N. Alansary, Mahmoud A. Ebada, Mohamed S. Abdelfattah, Ahmed K. El-Taher, Hazem S. Ghaith, Ibrahim A. Abdelhaleem, Notaila M. Fayed, Laila Fayed, Mohamed K. Mahmoud, Esraa E. Mohamed, Amr M. El-Deeb, Islam M. Mohamed, Abd Elrahman S. El kady, Mohammed Abd Al-Fattah, Mohamad Hassaan, Mohammed G. Hegazy, Amir Fathi Asla, Evangelos Fradelos, Dimitrios Korkolis, George Kavalieratos, Dimitrios K. Manatakis, Nikolaos Tasis, Argyrios Ioannidis, Michael Konstantinidis, Sofia Konstantinidou, Georgios Koukoulis, Christos Kalfountzos, Konstantinos Bouliaris, Dimitrios Schizas, Nikolaos Machairas, Stylianos Kykalos, Michail Vailas, Athanasios Syllaios, Panagiotis Dorovinis, Alexandros Kozadinos, Konstantinos Bouchagier, Francesk Mulita, Georgios Skroubis, Ioannis Maroulis, Grigorios Chatzimavroudis, Georgia Kotoreni, Petros Sountoulides, Christos Agalianos, Maria Ioanna Antonopoulou, Aristeidis Ladoukakis, Taxiarchis K. Nikolouzakis, Konstantinos Lasithiotakis, Emmanuel Chrysos, Sofia Xenaki, Efstratia Baili, Theodore Liakakos, Alexandros Charalabopoulos, Maytham A. Al-Juaifari, Yasir A. Zwain, Ahmed A. Himi, Hogir I.R. Aldawoody, Ishwarya Balasubramanian, Arnold D.K. Hill, William B. Robb, Martin Safari Aketch, Aaron M.J. Brady, Peter D. O' Leary, Jessie A. Elliott, Niall F. Davis, Ben Creavin, Paul F. Ridgway, Kevin Barry, Orlaith Kelly, Nicola Raftery, Matthew G. Davey, Ray P. McLaughlin, William P. Joyce, Aengus Meldon, Anna Fullard, Emmeline Nugent, Amenah Dhannoon, Paul Carroll, Stephen J. O'Brien, Emmet Andrews, Niamh M. Foley, Shane Killeen, Daniel Hechtl, Michael O'Riordain, John B. Conneely, Niall P. Hardy, Niall J. McInerney, Emma C. Kearns, Ben Shanahan, Czara Kennedy, Desmond Toomey, Shabhaz Mansoor, Eanna Ryan, Sean M. Johnston, Sean T. Lim, Irele Ifijeh Ahonkhai, Eltahir Eltagani, Odhran K. Ryan, Helen Earley, Joseph Garvin, Andru Nitharasan Iruthayanathar, Cillian Clancy, Brian Fahey, Haroon Rashid, Paul McCormick, Ian S. Reynolds, Darragh Garrahy, Orlagh Bean, Eoin Conlon, Des C. Winter, Emily Molony, Sean T. Martin, Emir Hoti, Anthony T. Stafford, Ann Hanly, Donal Maguire, Kin Cheung Ng, Benjamin Ngie Xiong Wong, Tom McCormack, Kin Yik Chan, Colin Peirce, Calvin Coffey, Nauman Nabi, Prem Thomas Jacob, Patrick Dillon, Abrar Ahmad, Peter Neary, Jessica M. Ryan, Tara M. Connelly, Fiachra Cooke, Peter W. McCullough, Gianluca Pellino, Lucio Selvaggi, Francesco Selvaggi, Gaetano Gallo, Francesco Pata, Cristiana Riboni, Michele Danzi, Marcello De Luca, Ruggero Lionetti, Luciano Grimaldi, Francesco Corcione, Michele Manigrasso, Marco Milone, Giovanni Domenico De Palma, Alessia Biancafarina, Valentina Mariottini, Marco De Prizio, Leonardo Solaini, Davide Cavaliere, Gabriele Vigutto, Antonio Castaldi, Alessio Palumbo, Carmine Antropoli, Valter Ripetti, Paolo Luffarelli, Gabriella T. Capolupo, Marco Caricato, Filippo Carannante, Michele Grassia, Andrea Lucchi, Antonio Schimera, Giuseppe Palomba, Giovanni Aprea, Carlo V. Feo, Nicolò Fabbri, Marco Torchiaro, Marcodomenico Mazza, Paolino De Marco, Giulia Bagaglini, Michele Grande, Pierfrancesco Lapolla, Andrea Mingoli, Gioia Brachini, Nicoletta Sveva Pipitone Federico, Marcello Calabrò, Alessandra Murgese, Alberto Aiolfi, Emanuele Mini, Davide Bona, Renato Patrone, Aurelio Nasto, Davide Pertile, Stefano Scabini, Domenico Soriero, Andrea Massobrio, Selene Deiana, Giacomo Carganico, Mauro Montuori, Enrico Pinotti, Giulia Carrara, Giorgio Lisi, Domenico Spoletini, Rosa Menditto, Marco Pace, Niccolò Petrucciani, Giuseppe Nigri, Diego Sasia, Martina Girardi, Giorgio Giraudo, Jacopo Andreuccetti, Stefano Rossi, Alessandro Scorsi, Caterina Puccioni, Biagio Picardi, Alessandro Anastasi, Riccardo Borreca, Elvira Adinolfi, Giuseppe Canonico, Tommaso Nelli, Francesco Carmignani, Edoardo Baldini, Olivia Boccia, Alessia Kersik, Francesco Fleres, Guglielmo Clarizia, Alessandro Longhini, Nicolo Mariani, Andrea Balla, Pasquale Lepiane, Sergio Petrocca, Maria Chiara Ranucci, Luca Morelli, Gregorio Di Franco, Francesco Porcelli, Simone Guadagni, Niccolò Furbetta, Andrea Romanzi, Maria Milanesi, Barbara Vignati, Alberto Vannelli, Roberta Scolaro, Antonella Putortì, Almu'atasim Khamees, Sami A. Almasarweh, Ali Guboug, Luai Abu-Ismail, Khayry Al-Shami, Sajeda Awadi, Manal Zain Mohammed Haij, Bourhan M.H. Alrayes, Manolia Al-Kubaisy, Mohammad Rashdan, Mohammad Abufaraj, Hanan Mansour, Ahmad A. Toubasi, Muayad Azzam, Tala Al-Aydi, Isam Bsisu, Oweiss Khrais, Mohammad Bani Hani, Hamza Daradkeh, Hussam Jamous, Mohammad Dardour, Renad Msameh, Hadeel Alasawdeh, Saeed K. Shumrakh, Yahya F. Oqdeh, Mohammad A. AL Hamoud, Amro Abuleil, Hazim Sameer Mohammad Ababneh, Muhammed Elhadi, Wisam A. Hasan, Ebrahim M. Ali, El Sharif F. Khalil, Ahmed Faraj Abaidalla, Haifaa Il Haddad, Mohamed G. Amnaina, Husayn M. Alabd, Sumayyah G. Bahroun, Eman Younes, Eman Al Sagheir, Ali Ali, Malak Khamaj, Mohamed Ashfersh, Reyad Ekhmaj, Issa A. Abuzeid, Mohammed N. Albaraesi, Salah S. Taktuk, Wafa Aldressi, Khalid F. Eltaeb, Jamal M. Gomaty, Hibah Bileid Bakeer, Akram Mohammed Alkaseek, Rehab Alarabi, Fatima Z. Gjam, Fras A.D. Elhajdawe, Ahlam M. Shuayb, Amin Egdeer, Ayman Almugaddami, Eman A. Abdulwahed, Reem Ghmagh, Entisar Alshareea, Doaa Gidiem, Aamal Askar, Sarah Aljamal, Abdulqudus Deeknah, Marwa Biala, Sharf Barka, Khaula Kamour, Hind Alameen, Anwaar Abozid, Mohamed Alsori, Sanad Kanna, Tahani Elgadi, Reyam Naana, Abdulrhman Marwan, Osama Omar, Jeremy Y.C. Teoh, Ida Nadiah Ahmed Fathil, Zainal Z. Adwin, Mohamedraed Elshami, Luis Adrian Alvarez-Lozada, Daniela G. Durán-Castro, Manuel E. de la O-Escamilla, Francisco J. Arrambide-Garza, Gerardo E. Muñoz-Maldonado, Alejandro Quiroga-Garza, Hind El Azzazi, Yousra El Assaad, Yassine Mrissa, Mouad Koukou, Chris Varghese, Mohammed K. Alqassab, Tracey Barnes, Mark W. Thompson-Fawcett, Matthew McGuinness, Josh Mitchell, Megan Grinlinton, Rowan Auchterlonie, Vilingatoni Hasiata, Christopher Harmston, Chelsea Allen-Brough, Lauren Siggins, George Weeratunga, Anthony Lin, William Xu, Holly Cook, Nusr Ghamri, Nejo Joseph, Helen Zheng, Milidu V.B. Ratnayake, Ian P. Bissett, Ademola Adetoyese Adeyeye, Mohammed Taofiq Olayinka, Yakubu Alfa, Muhammad Daniyan, Musliu Adetola Tolani, Muhammed Bashir, Keffi Mubarak Musa, Henry Ehidiamen Omon, Simon Adewale Balogun, Christopher Obinna Anele, Abdul Hafiz O. Adesunkanmi, Samuel Chibuzo Ajekwu, Ehis Afeikhena, Ifeanyichukwu Kelvin Egbuchulem, Ezeme Constantine, Naomi Olagunju, Ulasi Bartholomew Ikechukwu, Adegbolahan Fakoya, Olakoyode O Ogundoyin, Usama Waqar, Ronika Devi Ukrani, Maheen Mansoor, Tofique Asghar, Muhammad Jamaluddin, Muhammad Zahid, Farjad Ali, Tabish Chawla, Faiqa B. Aamir, Izza Tahir, Emaan Farhan, Kamran H. Dar, Abdullah B. Saeed, Usama Shahbaz, Muhammad Ilyas Alozai, Muhammad U. Akram, Sohaib Haider, Arrham Hai, Shaheer Ahmed, Akbar Hussain, Ahmed M. Durrani, Fawad M. Arbi, Fatima Khaliq, Muhammad Abubakr, Noor Khalid, Rizwan Khalid, Aqsa Iqbal, Arwa Javed, Hamza Akhtar, Bilal M. Malik, Hashim Khan, Adam U.A. Butt, Abdur R. Malik, Daniya S. Malick, Aiza Asif, Muhammad Sarfraz Khan, Muhammad Idrees Anwar, Sadia Yaqoob, Furqan A. Jarullah, Farooq Umer, Soomal Jamil, Mohammad Zarin, Adel Khan, Mansoor Alam, Mahnoor Shafi, Samra Fakhar, Amrat Ayaz Ali, Nawaz A. Dal, Marvi Shams, Sundas Laghari, Yash Kumar, Syed Atif ul Haq, Areeba Abdullah, Sheeraz Ur Rehman, Farhan Javed, Wasaq Ali, Shahzaib Ahmad, Prabesh Joshi, Muhammad Zeeshan Sarwar, Syed Asghar Naqi, Muhammad I.H. Daula, Muhammad Tayyab Ijaz, Talha bin Fazal, Amna Javaid, Akram Rajput, Layiba Masroor, Tooba Shahab, Aimen Yaqub, Sufian M. Zahid, Naveed Jabbar, Muhammad Hassan Javeed, Muhammad Qaisar Karim, Muhammad Asad Jamal, Mishaal Fazal, Fahd Mudassar Hameed, Mahnoor Bakhtiar, Aamena Akhtar, Zartaj A. Khan, Kiran Rehman, Rehan A. Khan, Fareeha Farooqui, Sibgha Aimon, Iqra Marjan, Yousef K. Al-Saba'a, Dana M. Alkahlout, Fatima M. Amer, Omar Mostafa, Deema Sami Naim, Mahmoud Manasra, Yazan Giacaman, Aya Zawahra, Myyas N. Erman, Tamara K. Abu Reyash, Sarah M. Shami, Amjad H. Awwad, Hamdoon Abu-Arish, Osama Y. Aljabarein, Saja Alkomi, Raghad Dweik, Khalil O. Atatra, Fawzi Hesham Yasin, Reem J. Saad, Abdellatif Khader, Reema A. Hussein, Ameer A. Helles, Ruba S. Ismail, Mustafa A. Abu Jayyab, Mohammad Hasson, Ana Povo, Cláudio Silva, Mariana Ginestal, Ionut Negoi, Valentina M. Negoita, Tamás Talpai, Cătălin-Alexandru Pîrvu, Stelian Pantea, Ruslan Menzulin, Alexey Yanishev, Andrey Bazaev, Natalia Chubukova, Maxim Bagrjancev, Maxim Ryabkov, Alexander Abelevich, Anastastia Novikova, Reham J.M. Saeed, Tarek M. El-Mansoury, Amer M.A. Khogaly, Danijel Galun, Marko Zivanovic, Monica Serrano-Navidad, Aitor Landaluce-Olavarria, Begoña Estraviz- Mateos, Aitor Sainz-Lete, Melania Gonzalez-De Miguel, Julio Zevallos-Quiroz, Alba Vázquez-Melero, María Sánchez-Rubio, Imanol Herrero López, David García López de Goicoechea, Maite Camuera González, Pablo Helguera Martínez, María Balluerca Alba, Patricia Paunero Vázquez, Isami Soeda Seminario, Fernando Mendoza Moreno, Belén Matías-García, Ricardo Alvarado-Hurtado, Sonia Soto-Schütte, Marta Alberich Prats, Zoilo Madrazo González, Jaime López Borao, Albert Sueiras Gil, Silvia Martin Santos, Marta Gil Barrionuevo, Gerardo Rodriguez-Leon, Josep Vallet Fernandez, Carles Ortiz Rodriguez, Ramiro Hevia Falú, Vicente Gil Gomez, Alex Biel Arrufat, Ana Alberca Páramo, Eva Antonaya Rubia, María A. Rodríguez Cano, Piedad Ruíz Frías, Sara Gortázar de las Casas, Federico Del Castillo Díez, Jenny Guevara Martínez, Fernando Prieto La Noire, Nuria Chavarrías Torija, Santiago Valderrabano Gonzalez, María Heras Garceau, Jaime Otero de Pablos, Antonio Ramos Bonilla, Diego T. Enjuto Martínez, Lorena Rodríguez Gómez, Patricia Diaz Peña, Judit Gonzalez Guerreiro, Iria Cervera Celdrán, Elima Cagigal Ortega, Antonio García Domínguez, Ana Alvarez Cuiñas, Carla Soldevila-Verdeguer, Laura Fernández-Vega, Naila Pagès-Valle, Alejandro Coello-González, Enrique Colás-Ruiz, Weerakkodige Mithun Chamindaka Alwis, Rathnayake Mudhiyanselage Dulanee Karunarathne, Ginimal Bandaralage Kavinda Deshapriya Bandara, Vitharanage Srimantha Dewsiri Rodrigo, Umesh Jayarajah, Salaheddin M. Abdulhamid, Fares Kh. Almokdad, Alrayah E. Senhuri, Weaam M. Abdullah, Elharith H. Abdelwahid, Alhaj O. Idris, Sami Galal-Eldin, Hytham K.S. Hamid, Alaa M.E. Mohammed, Ahmed M. Ibrahim, Samar G. Ahmed, Osama S. Osman, Mohammad El Tahier Abdalla Omer, Fthelrahman M. Toum, Fatima Mohammed Sabir, Abdulhafiz Yaghoub Ali, Abdelfatah A. Abdelmageed, Ashraf Khalafalla, Luden Saif Aldawla Hassan, Mai D. Mahmoud, Mugahid A. Salih, Alaa Hamdan, Mazen Mohammad, Mohamad Al Shareeda, Mohammad Baraa Otaky, Ali Nashed, Hussein Zayat, Mohammad Aloulou, Mohamed H. Alsmail, Fatima Sawas, Rafah Alghareeb, Aghyad Kudra Danial, Mohammad A. Abdullah, Khaled Krad, Ruqaya Masri, Omar Alannaz, M.Yasser Halwani, Mohammad Maen Ghannam, Ranim Kazzaz, Shergal Tammo, Ahmad Ghazal, Madian Alabad, Hasan Alhasan, Ahmad Alhaj, Ahmad Aljaber, Bakri T. Jarkas, Habib Olaisheh, Bassam Hassan, Ahmad Amir H. Kayali, Mohannad Nasani, Hasan F. Kayali, Ziad Alahmad, Khaled Arnaout, Aya A.N. Laila, Kamal Zalf, Hussain Hasson, Shant N. Apelian, Hawazen A. Makhluf, Fadwa F. Ibraheem, Ahmad Y. Arnaout, Hamza Ibrahim, Mohammad Sharifa, Samer Nastah, Mohammed A. Zayat, Ahmad Tarky Alhashash, Dani S. Konaizeh, Zuhair Rostum, Hasan Y. Ahmad, Fater Aliskander, Ahmad Saad, Arda Isik, Ufuk Memis, Saniye Salih, Kemal Tolga Saracoglu, Ummahan Dalkilinc Hokenek, Ozan Can Tatar, Syed Faraz Ali Shah, Nuh Zafer Cantürk, Enes Şahin, Sertaç Ata Güler, Turgay Şimşek, Cem E. Guldogan, Emre Gundogdu, Mahir M. Ozmen, Tevfik Kıvılcım Uprak, Melike Zeynep Can Şahin, Semra Demirli Atici, Kenan Teker, Ahmed Aktas, Javed Latif, Frank McDermott, Hans Lederhuber, Venla Kantola, Samantha Muse, Nasir Jaralla, Dorina Roy, Alison McCoubrey, Azel Botes, Alexander Booth, Colston Edgerton, Fatima Al-Eryani, Hamza Al-Naggar, Salwa Al-Eryani, Ghadeer AL-Wajeeh, Khadega Abotaleb, Mohammed Al-Shehari, Sarah Shream, Ramzi Alsayadi, Shada Alemad, Bushra Hussein Alshaikh, Manal Jamal Al-Dhaheri, Wadhah Ahmed Al-Hajj Al-Fakih, Khaled A. Telha, Wail M. AlQatta, Ghassan K. Telha, Ali Güner 
Journal: JAMA Surgery (2023)

Importance Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors. Objective To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR. Design, Setting, and Participants The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR. Exposure Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia. Main Outcomes and Measures The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients. Results In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72). Conclusions The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies.